Med/Surg and the Bad, Horrible, Terrible, No-Good Day

[VivaLasViejas]

It all started so innocently: put on standby from 11A-3P, then called back in at 1115 because one nurse wanted to go home. I came in, happy because call-back means time-and-a-half for those first four hours. It all went downhill from there.

First thing, I get a discharge and two admits (one of which is from the doctor's office, so they have no IV or orders). The other admit has a K+ level of 2.3, so she's got to have mag sulfate plus K-riders---six of them, given over six hours---while she is to be monitored on telemetry AND closely observed for any adverse reaction. In the meantime, I have a tube-feeder who gets meds every hour or two and is having frequent diarrhea due to C.diff, two incontinent female patients who pee about every 15 minutes, and a family of 20+ people milling around the room of another patient who's expecting to be discharged.

At 4PM the doctor for this latter patient called and gave me a T.O. to D/C her with her current home meds, plus insulin, and have her follow-up with him on Monday as he was on his way out of town for Easter weekend. I took the orders, then realized something: the patient had never even been ON insulin before this hospitalization, and since she'd been admitted with altered LOC I thought she was probably NOT the best candidate for learning how to administer insulin. Not only that, I literally had no time to teach her or her family this task, you can't get hold of a diabetic educator at 1600 on the Friday of a holiday weekend, and everyone else was as busy as I was.......so I called this MD back, told him what the deal was, and his reply was "Oh, it shouldn't take more than 3 minutes to teach her how to give herself insulin. I'll see her in my office on Monday anyway". ~Click~

OK, so how does that get the patient through the weekend? I've taught insulin administration before, and it always took me an hour at bare minimum to explain the equipment and the rationales, the proper technique for drawing up the insulin and injecting it, and have the learner do a few return demonstrations, first on an orange, then on themselves and/or their family member. This patient had some mild dementia due to chronic hypoxia and her family didn't know the first thing about how to do this.......so since I didn't have time to do the proper instruction (and thought it would be irresponsible to let her go home without it) I turfed it to the next shift after unsuccessfully trying to enlist assistance from pharmacy, the nursing supervisor, and several other nurses.

Of course, by now the patient and family were becoming upset (for which I don't blame them), the MD on call was no help whatsoever ("What's the big deal? Just show her how to take the insulin and send her home") and I was getting frustrated because I'd been late with all my other patients' meds while trying to get this patient the teaching she needed. The night-shift nurse and I got the night supervisor involved since we weren't getting anywhere with the MD, and it turned out that the patient ended up staying another night after the VP of nursing threatened the doc with being reported to the Internal Med board if he didn't give us an order to hold the discharge until diabetic teaching could be done.

So then I had to write a page full of progress notes, along with an incident report, and I ended up staying an hour and a half past the end of my shift :stone The thing that bugs me, though, is that BOTH of these doctors seemed to think this was no big deal.......they didn't really care if the patient/family knew what they were doing or not, and they sure as hell didn't care that a floor nurse with five very busy patients didn't have the time to teach this task properly. The patient's doctor was too busy getting out of town, and the on-call MD couldn't have cared less. :angryfire

Now, of course, the fecal matter is on target and headed straight toward the oscillatory ventilation system, because I did write an incident report which I know is going to make the doctors look bad---and frankly, I think we ALL look bad here, myself included, because I couldn't take the time to do this teaching AND manage my other patients. You know how a hamster looks when he's running and running on that little wheel, only to fall off over and over again? That's how I felt yesterday......man, it was ugly out there, and it may get uglier before it's over with.

Did I say I love my job? OK, now I'm going to breathe deeply and say to myself: IlovemyjobIlovemyjobIlovemyjobIlovemyjob...... :stone

[warrior woman]

Hey there Marla! You are the true spirit of what nursing is about. If you remember that, you are a step ahead of everybody else. Your patients are lucky to have you my friend. Sometimes you just have to say a short version of the Serenity Prayer and chuck the rest of it in the wastebin. It's what's saved me so far. WW.